I was diaginosed with HIV on 2/17/04. On 3/02/04 cd4-268 and viral load-1700. Treatment with Kaletra and Combivir began on 03/17/04. On 04/27/04 cd4-240 and viral load undetectable. On 05/21/04 cd4-219 and viral load undetectable. I'm pleased that my viral load is undetectable however my cd4 count continues to drop. My doctor says I should not worry about the cd4 count however my reasearch shows that a cd4 count below 200 is the number at which opportunistic infections occur. At the current rate of decline in cd4 since 03/02/04 I may likely fall below 200 within a month. I'm am very concerned about this and think my doctor should be as well. Am I correct?

Also, at my intital diagnosis with cd4-268 and viral load only 1700 is this treatment course appropriate?The research I've done shows Kaletra and Combivir to be a very aggressive treatment. Was this warranted considering my low viral load?

Response from Dr. Sherer

It is still quite early to be judging the outcome of your therapy on the basis of the CD4 cell count. In the majority of patients with your results, the CD4 count will rise, usually by 4-6 months of therapy.

Some other information may be of use. Did the CD4 percentage also fall by more than 3% during this period? If not, you may be seeing only a relative drop in the CD4 cells. You might also find that the total lymphocyte count also dropped.

I would simply await the CD4 and viral load values at 4 and 6 months before changing therapy, if this regimen is otherwise tolerable. Indeed, the boosted PIs generally are associated with fairly prompt and rapid rises in CD4 cell counts. This also may indicate that you and your doctor need to explore other possible causes for low CD4 cells and/or lymphocytes.

Finally, about 10-15% of patients with a good response to ART have a less than optimal response to ART, and little or no rise in their CD4 cell counts. IF this persists, a change in regimens would be warranted.

I urge you to talk with your doctor about these issues, and resist the temptation to abandon this regimen too quickly, if it is otherwise well tolerated and suitable for you.

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